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Background: Pulmonary sarcomatoid carcinoma is a rare type of non-small cell lung cancer with poor prognosis. It is more common in males, has a strong association with smoking, and makes up mere 1.3% of all lung cancers. Our study examined the epidemiology, natural history, and prognostic factors of sarcomatoid lung carcinoma using a population-based registry.

Methods: The Surveillance, Epidemiology, and End Results (SEER) Program database was utilized to isolate cases by tumor site and histology codes. The association between clinical and demographic characteristics and long-term survival was assessed.

Results: A total of 582 histology confirmed cases were identified between 1973 and 2014. The median age of the patients was 68 years (range 29–96). Of the patients with a known tumor stage (N = 477), 74.8% had regional or distant stage, and 95% of patients with known histologic grade, had poorly or undifferentiated histologic features. 60.8% received surgical intervention. The median overall survival was 12 months (95% CI 9–14 months). In a multivariate analysis, age, sex, and SEER tumor stage were found to be a significant prognostic factors for disease specific survival. The prognosis of sarcomatoid carcinoma of the lung remains dismal, even in patients with resectable disease. Patients who underwent cancer directed surgery (64%) had median survival of 19 months with 1, 5 and 10-year survival rates of 63.7%, 33.6% and 28.8% respectively. Those patients who did not undergo cancer directed surgery (36%) had a poorer prognosis with a median survival of 4 months and 1, 5 and 10-year survival rates of 19.8%, 6.7% and 6.7% respectively.

Conclusions: Sarcomatoid lung carcinoma often presents as a high grade, advanced malignacy with aggressive behavior and a dire prognosis. Patients are younger and yet have shorter survial times than those with more common lung cancers. Emphasis on new strategies for early detection and identification of additional risk factors, and noval therapies will be important to improve the outcome for patients with this malignancy.

Clinical trial identification:

Legal entity responsible for the study: Atul Narayan Sharma

Funding: Has not received any funding

Disclosure: All authors have declared no conflicts of interest.

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